HomeMy WebLinkAboutMortgage_Cobb"'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
; FOR DEDUCTION FROM ASSESSED VALUATION
'— State Fam 43709 (R71 / 6-09)
S PrewibeG by Departmem o1 Loral Govemment Fu�ance
�vsrnuCnoNS: a
o be filed in erson w b mail wiN !he Coun Auditw or Coun Recorder ol fAe mun wheie the ro F ���
P Y fY �Y �Y P a�m � r��e¢A N
Fifirg Dafes: 1 J Real Properry: Must file dunng Ne year for which Na deduction is sought. �,ZCounty Auditor
2) Mobile / Manufactured Homes not assessed as Real Property Must file dunng the Rvelve (12) months
6etore March 37 o/each year the deduction is sought ���� M �\ .,,County Reoordu
See reverse side for additional instructions and quali(cations_ �
Aoo5wm �aroontradbtnau-seerfibir�msonreversesidel " ' ' H OR
curtentyeer
Ii no,
It nam¢ on tCCOrd 5 diftereni Nan (hai ot appGC2nt 'uiOiWte below.
Name o( tMrt�agee b mntract Seller �/ �
unpaid az o( Morl
date
If owned wiN �.
Address o( mortgagee w mntract seDer (number and sn5ef. cRy, sfate. arM ZIP code)
sfate,
Dces appficant am property in any oUier I If yes, what couny?
�,�ry �� i�a��a
❑ Yes ❑ No
Deduction app�w�.d'oi tlre amount of.
2� _
Sigfance d Camry Auditw
20 _ i �
COUNTYAUDROR
.' oL W
ct viEe6ted�ss ipaid as of Is Me aP�+t Ne sWe
i 2 p V legal w epuipde amM
ojOO ❑ Yes ❑ No
zo_ i Zo_
Caunry
I/ We certify under Ne penalty of perjury that the above and (oregoing infortnalion is We and
owner / conVact buyer of ihe aforementloned property on date applicaaon is filed.
XSigfanue ` �sfu9na e .� n�
i�Full �esulent aEtlress o( a pinan�nu � antl sheet dry,�y e, rM Z/P )/
l�`.,4-,� _� !/YI�. ;,. .�f� �9(/�i�n.�.,/
Addtess of authrnved person (number arM Stn.`e( city. 5tafe, and ZIP CoUe)
spouse. indirate with wMm
Is ihe property in quesGOn: MnuaP) Assesse0
❑ Real ProPertY ❑ MnualyAssessed
Mas ihis deEUCim Ocen requestt� �^ "
rw a,�u y�n. -
Co3a, �a-
�
I I-S�Sa
ihat the applinnt is a resident of IrMiana arM
Date (nmth. daY• Y�h